ABSTRACT
Sometimes the decision to offer radiotherapy may be relatively simple if the disease is common, the treatment effective and standardised, the histological features well categorised, and imaging easy to interpret. Some breast cancers fit well into this category. In contrast, decisions may be very difficult if there is no treatment of proven benefit, the prognosis is uncertain, the patient’s general performance status is poor, imaging is of limited usefulness or there is histological uncertainty. Clinical experience and judgement is then critically important. This expertise is built on the foundation of good history taking which enables us to set the patient’s disease in the context of their own ideas, concerns and expectations. Have other family members had radiotherapy with good or bad outcomes? Are they so claustrophobic that they will not go into a scanner or treatment room? Do they have other problems which would affect the feasibility of radiotherapy – arthritis which limits joint movement, shortness of breath which prevents them lying flat, heart valves or prostheses which may affect dose delivery?
